Reporting of hospital-acquired conditions, as well as other suspected serious problems associated with drugs and/or medical devices, is an important mandate of healthcare providers and healthcare institutions. It might be on an institutional or individual level where quality assurance and performance issues are being reviewed and monitored, or it might be on a state or federal level where there is a need to understand the extent of a certain problem and how interventions affect it.
Whatever the situation, reporting in most instances is voluntary and in many instances can be done on line, by phone, or by submitting collected data and reports. The following are just a few agencies that collect, analyze and report important data regarding hospital-acquired conditions and device malfunctions. The value of these reports is that they can serve as benchmarks for your own experiences and as a guide for improvement. These types of reports and reporting certainly represent one aspect of public accountability.
Federal Level Reporting
The National Healthcare Safety Network (NHSN)
The NHSN is a secure, internet-based surveillance system that integrates patient and healthcare personnel safety surveillance systems managed by the Division of Healthcare Quality Promotion (DHQP) at CDC. There is no charge for participation in the NHSN.
The purposes of NHSN are to:
- Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the magnitude of adverse events among patients and healthcare personnel.
- Collect data from a sample of healthcare facilities in the United States to permit valid estimation of the adherence to practices known to be associated with prevention of healthcare-associated infections (HAI).
- Analyze and report collected data to permit recognition of trends.
- Provide facilities with risk-adjusted data that can be used for interfacility comparisons and local quality improvement activities.
- Assist facilities in developing surveillance and analysis methods that permit timely recognition of patient and healthcare personnel safety problems and prompt intervention with appropriate measures.
The Centers for Medicare & Medicaid Services (CMS)
CMS has recently updated the "Reporting" section of the Hospital-acquired Conditions (HAC) & Present on Admission (POA) Indicator Reporting website to describe the remark code that is being shared with providers who are improperly submitting Present on Admission Indicator data. A description of the remark code is available in the "Reporting" section.
To keep up to date with the latest information from The Centers for Medicare & Medicaid Services (CMS) regarding "Reporting" of the Hospital-acquired Conditions (HAC) & Present on Admission (POA) Indicator (s) go to the CMS website which includes an overview of the statute (Section 5001(c) of the Deficit Reduction Act (DRA)); conditions for October 1, 2008 implementation, conditions being considered for 2009, and finally, conditions needing further analysis. It also contains a section with educational resources which includes downloadable documents e.g. Hospital-acquired Conditions (HAC) in Acute Inpatient Prospective Payment System (IPPS) Hospitals and a number of audio presentations.
Division of Healthcare Quality Promotion (DHQP)
The Division of Healthcare Quality Promotion (DHQP) is part of the National Center for Infectious Diseases in CDC’s Coordinating Center for Infectious Diseases. The mission of DHQP is to protect patients, protect healthcare personnel, and promote safety, quality, and value in the healthcare delivery system by providing national leadership for nine key areas:
1) Healthcare outcomes,
2) Outbreaks in healthcare settings,
3) Emerging antimicrobial-resistant infections,
4) Efficacy of new interventions for patient safety,
5) Clinical microbiology laboratory quality,
6) Water quality in healthcare settings,
7) Cost effectiveness of prevention / interventions,
8) Promotion of implementation and evaluation of prevention interventions, and
9) Development of infection control guidelines and policies.
The following is a summary of state activity and legislation regarding the disclosure by hospitals of their hospital infection rates.
As of June 15, 2008:
- 22 state laws require public reporting of hospital-acquired infection rates (CO, CT, DE, FL, IL, MD, MN, MO, NJ, NY, NH, OH, OK, OR, PA, SC, TN, TX, VA, VT, WA, WV);
- 2 state laws require public reporting of infection information, but not specifically infection rates (CA, RI);
- 2 state laws require confidential reporting of infection rates to state agencies (NE, NV);
- 1 state has a voluntary law requiring public reporting of infection information (AR)
- All other states except WY, AZ, MT and ND have considered hospital infection reporting laws, but have not yet passed legislation. Click here for further updates.
The Health Transparency website tracks new and updated healthcare reports on quality, pricing, and consumer satisfaction. It links to individual states and covers news and information on healthcare for that state. Here is an example of how an individual state is handling their cost reporting.
Pennsylvania Healthcare Cost Council
Pennsylvania Healthcare Cost Containment Council is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of healthcare, and increasing access for all citizens regardless of ability to pay. The website is a good source of data (2005) regarding number of cases of HAI, the average length of stay, and related costs.
- The average payment for a hospitalization in which a patient acquired an infection was $53,915, while the payment when a hospital-acquired condition was not present averaged $8,311. The differences in payment varied by the condition that brought a patient to the hospital.
Institution Level Reporting
Infection statistics should be documented and retained. One method of reporting and recording this event is shown on the Institute for Healthcare Improvement (IHI) website:
- The ventilator-associated pneumonia (VAP) rate is defined as the number of ventilator-associated pneumonias per 1,000 ventilator days. In this case, for a particular time period, we are interested in the total number of cases of ventilator-associated pneumonia in the ICU. For example, if in February there were 12 cases of VAP, the number of cases would be 12 for that month.
- To understand VAP rate, here is an example. If 25 patients were ventilated during the month and, for purposes of example, each was on mechanical ventilation for 3 days, the number of ventilator days would be 25 x 3 = 75 ventilator days for February. The ventilator-associated pneumonia rate per 1,000 ventilator days then would be 12/75 x 1000 = 160.
The Joint Commission
The Joint Commission's goal is to continuously improve the safety and quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.
- Centers for Disease Control (CDC) National Healthcare Safety Network
- Centers for Medicare & Medicaid Services (CMS) website
- CMS Reporting - Present on Admission Indicator Page
- CMS Hospital-acquired Condition Information Page
- Division of Healthcare Quality Promotion (DHQP)
- Infectious Diseases Society of America (IDSA) website